Infertility Research Articles

Screening for congenital adrenal hyperplasia in infertile women with high androgenemia during childbearing age

Objective The causes of infertility are complex and diverse, and congenital adrenal hyperplasia (CAH) is often overlooked in screening for infertility. In this study, CAH was diagnosed in women with high androgenemia who were infertile during childbearing age, and the diagnosis and treatment of CAH in pregnant women was investigated. Methods This study included 20 women with high androgenemia and infertility in the childbearing age who were referred to the Endocrinology Department after visiting the Reproductive Medicine Center of the First Affiliated Hospital of Nanjing Medical University from December 2016 to April 2019. All patients were tested for blood hormone levels, glucose, and lipid metabolism, underwent ACTH stimulation test, uterus and bilateral ovarian B-ultrasound, adrenal computed cosmography (CT), etc. Full-length sequencing of the CYP21A2 gene was performed as necessary. Results Among the 20 women with hyperandrogenism who were infertile, there were 7 cases of CAH (35.0%), including 6 cases of 21-hydroxylase deficiency (21-OHD) confirmed by gene sequencing; 10 cases of polycystic ovary syndrome (PCOS); 3 cases of idiopathic hyperandrogenemia (IHA). Sex hormone results showed that testosterone in CAH group was significantly higher than that in PCOS group and IHA group [(4.4±2.0 vs 2.9±0.4, 2.8±0.8) nmol/L, P 0.05]. However, the 17-OHP (60 min) in CAH group was significantly higher than that in PCOS group and IHA group [(200.1±80.8 vs 3.1±1.2, 3.4±0.2) ng/ml, P<0.05]. Glucocorticoid therapy was given to patients with CAH, and 4 patients had successful pregnancy. No clinical symptoms of CAH and external genital malformations were found in the offspring of patients who had been delivered. Conclusions The ACTH stimulation test is of great significance in the differential diagnosis of CAH, especially 21-OHD. Genetic testing helps to identify the type of mutation in CAH patients. On the one hand, glucocorticoid therapy may improve the pregnancy rate of CAH patients, on the other hand, it can help to reduce the status of maternal high androgen and avoid masculine manifestation of female offspring. Key words: Infertility; Hyperandrogenism; Congenital adrenal hyperplasia; ACTH stimulation test

Effect of WeChat management on the outcome of infertility patients with high bmi polycystic ovary syndrome

Objective To investigate the effect of WeChat continuation management on the outcome of diagnosis and treatment in patients with polycystic ovary syndrome (PCOS) with high body mass index (BMI) in infertility clinics. Methods A total of 61 PCOS patients with a BMI of >25 kg/m2 were selected as subjects.According to the random number table method, 30 patients were included in the observation group and 31 patients in the control group.On the basis of routine diagnosis and treatment, patients in the observation group were administered diet, exercise and psychological state for 1 year through WeChat group.Compliance behavior, weight loss and pregnancy status of the two groups of patients were evaluated. Results Compared with the control group, the differences in compliance, weight loss, pregnancy, anxiety and depression were statistically significant(P<0.01). Conclusions WeChat continuation management has a positive synergistic effect on the treatment of PCOS infertility patients with high BMI. Key words: WeChat continuation management; Body mass index (BMI); Polycystic ovary syndrome (PCOS)

Correlation between urinary phthalate concentration and semen quality parameters

Objective To explore the correlation between urinary phthalate concentration and semen quality parameters. Methods A total of 112 males with infertility in our hospital were set as infertility group. Another 65 healthy males who had given birth during the same period in our hospital were selected as control group. The semen samples obtained by urine and masturbation were collected in all the subjects. The semen quality parameters were detected by automatic color sperm quality detection system, and the concentrations of dimethyl phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP) and Di 2-Ethyl Hexyl Phthalate (DEHP) in urine were measured by high performance liquid chromatography, and the correlation between concentrations of four phthalates and semen quality parameters was analyzed by spearman correlation coefficient. Results The concentrations of DMP, DEP, DBP, DEHP and total phthalate in infertility group were significantly higher than those in control group (P<0.05). The sperm density, sperm survival rate and ratios of a+ b level sperm and forward movement in infertility group were significantly lower than those in control group (P<0.05), and the ratio of abnormal sperm was significantly higher than that in control group (P<0.05). The concentrations of DMP, DEP, DBP and DEHP in urine were negatively correlated with sperm density, sperm survival rate and ratios of a+ b level sperm and forward movement (P<0.05), and were positively correlated with abnormal sperm ratio (P<0.05). Conclusions The concentration of phthalate is high in urine of infertile males, and its concentration is negatively correlated with semen quality. Phthalate accumulation may be one of the important reasons for male infertility. Key words: Urinalysis; Phthalate; Semen analysis; Infertility, male

Effects of depression on the quality of life of infertile couples: a study based on the Actor-Partner Interdependence Model

Objective To study the effect of depression on the quality of life of infertile couples by using a binary analysis method, namely the Actor-Partner Interdependence Model (APIM). Methods A total of 191 infertile couples admitted to the reproductive center of Peking union medical college hospital from May 2019 to August 2019 were selected for a cross-sectional survey using the simplified Chinese version of FertiQoL and PHQ-9, and the path relationship of the mutual influence of the quality of life of couples was analyzed through the Actor-Partner Interdependence Model. Results Depression in both wives and husbands significantly predicted their own quality of life (β=-0.569, P<0.01; β=-0.588, P<0.01), the main effect was significant. In terms of object effect, male depression had a significant effect on women's quality of life (β=-0.253, P=0.032), while wife depression had no statistical significance on men's quality of life. Conclusions The results confirm that the quality of life of infertile couples is affected by individual and object depression. Therefore, evaluating both partners from a systematic perspective can improve the complexity of psychological problems in infertile couples and help healthcare professionals develop interventions to help infertile couples manage psychological and social stress. Key words: Fertility quality of life scale; Depression; Infertility; Model of subject and object interdependence

Correlation between stigma and posttraumatic growth in female infertility patients

Objective To explore the current situation of stigma and posttraumatic growth in female infertility patients, and to analyze the correlation between them. Methods From January to May 2019, this study selected 110 female infertility patients of reproductive medicine center in a ClassⅢ Grade A hospital of Zhejiang Province as subjects by convenience sampling. Those infertility patients were investigated with the general information questionnaire, Infertility Stigma Scale (ISS) and the Post-traumatic Growth Inventory-Chinese version (PTGI-C) . A total of 110 questionnaire were sent out and 104 valid of them were collected. Results Among 104 female infertility patients, the score of ISS was (67.14±14.33) with the intermediate level; the score of PTGI-C was (63.92±11.76) also with the intermediate level. There were statistical differences in the scores of post-traumatic growth among female infertility patients with different education levels, characteristics and whether being the only child (P<0.05) . The scores of ISS of female infertility patients had statistically negative correlations with the total score and dimension scores of PTGI-C (P<0.01) . Hierarchical regression analysis showed that the main influencing factors of posttraumatic growth in female infertility patients were the education levels, years of infertility, total score of stigma and scores of emotion and behavior with statistical differences (P<0.05) . Conclusions Stigma of female infertility patients is negatively correlated with the posttraumatic growth, which points that nurses could positively reduce the stigma of those patients so as to improve their posttraumatic growth. Key words: Female; Infertility; Stigma; Posttraumatic growth

Endometriosis and Infertility

Endometriosis and Infertility

Chlamydia trachomatis elicits TLR3 expression but disrupts the inflammatory signaling down-modulating NFκB and IRF3 transcription factors in human Sertoli cells.

Chlamydia trachomatis, the leading cause of bacterial sexually transmitted diseases worldwide, can disseminate and localize to the upper genital tract impairing reproductive function. Specifically, ascending C. trachomatis genital infection has been demonstrated to cause epididymitis or epididymo-orchitis, well-known risk factors for male infertility. C. trachomatis possesses the ability to infect primary human Sertoli cells, key elements for the spermatogenetic process and the immune protection of germ cells. Therefore, herein, we investigated the innate immune response in Sertoli cells following C. trachomatis infection, as well as its indirect effects on human spermatozoa. Specifically, we evaluated C. trachomatis mediated induction of Toll-like Receptors (TLR) 2, 3 and 4 as well as of downstream intracellular signaling molecules (NFκB and IRF3) and the levels of the related inflammatory mediators (IL-1α, IL-6, IFN-α, IFN-β and IFN-γ), in an in vitro infection model of primary human Sertoli cells. The main result of our study shows that C. trachomatis induced TLR3-mediated recognition in human Sertoli cells, accompanied by the down-modulation of NFκB and IRF3-dependent signaling pathways followed by no production of pro-inflammatory cytokines. In conclusion, our findings suggest that C. trachomatis can disrupt the innate immune response in Sertoli cells and evade intracellular killing, potentially giving rise to a long-term infection that may exert negative effects on the male reproductive system.

Fish Oil Supplements Are Associated with Better Testicular Function

Studies in men who are part of infertile couples have shown an association between testicular function and use of fish oil supplementation. Researchers

Psychology and adaptation of couples during in vitro fertilization-embryo transfer: a qualitative study

Objective To understand the psychology and inter-adaptation of patients with in vitro fertilization-embryo transfer (IVF-ET) and their spouses. Methods From August to November 2017, this study selected 13 females with IVF-ET and 13 spouses in Reproduction Center of a ClassⅢ Grade A hospital in Anhui Province as subjects by purposive sampling. In-depth semi-structured and individualized interview was carried out for those subjects with the phenomenology study of qualitative research. Colaizzi 7-step analysis was used to sort out and analyze interview data. Results Psychological pressure was common in patients with IVF-ET and their spouses and interacted with each other. Totals of four themes were extracted separately, in patients: (1) being worried about IVF-ET and marital status; (2) bearing stress from family, social and themselves; (3) changes of life style and relationship between husband and wife; (4) coping with stress and adjustment mode solely; in spouses: (1) being worried about IVF-ET and physical condition of their wives; (2) bearing stress from family, work and economy; (3) changes of life style and relationship between husband and wife, (4) lack of coping with stress and adjustment mode. Conclusions We should pay attention to psychological pressure and interaction of IVF-ET patients and their spouses, influence of spouse support and coping style on psychology of IVF-ET patients. Take professional measures to improve the pregnancy outcome by providing targeted health guide and psychological intervention for couples. Key words: Infertility; Sterility; Fertilization in vitro-embryo transfer; Psychological pressure; Spouses; Qualitative research

Research progress of imaging examination in male infertility

At present, male infertility has become a serious social and medical burden in all countries in the world, and reduce people′s happy life index. Base on this, radiologists and clinicians are trying to find some new technologies of the medical image examination methods, including X-rays, B-ultrasound, magnetic resonance imaging, etc, attempt to obtain the exact etiology diagnosis of male infertility in order to get more effective treatments and benefits with more happy families. This article of reviews the application and research progress of the latest imaging techniques in the etiological diagnosis of male infertility in recent years. Key words: Infertility, male; Radiographic image enhancement; Ultrasonography, doppler; MRI

Clinical effect of seminal granulysin levels in infertile men with varicocoele

Objective To investigate clinic effect of seminal granulysin levels in infertile men with varicocoele. Methods From September 2016 to July 2017, a total of 80 infertile patients as observed group, including infertile with varicocoele(n=45) and infertile without varicocoele (n=35), and 30 healthy men as control group were studied in this research. All participants had semen analysis and estimation of seminal granulysin expression. Results Seminal granulysin expression was significantly higher in infertile men than control group. Among infertile men, seminal granulysin expression was significantly lower in those with VC than in those without. Besides, seminal granulysin expression was negatively correlated with sperm concentration(r=-0.364, P<0.001), sperm motility (r=-0.397, P<0.001), and sperm normal forms (r=-0.441, P<0.001). Conclusions Seminal granulysin expression is significantly lower in infertile men than in fertile men being lowest in infertile men associated with VC. Granulysin levels are significantly correlated with VC grade. Key words: Varicocele; Infertility, Male; Semen Analysis; Eosinophil Granule Proteins

Microscopical spermatic vein ligation combined with shaofu zhuyu decoction for the treatment of varicocele caused by sthenospermia

Objective To investigate the clinical effect of varicocele(VC) induced oligospermia treated by arterial microvascularization combined with shaofu zhuyu decoction. Methods From March 2016 to October 2018, 50 cases of VC infertility patients were seleced and randomly divided into treatment group and the control group(n=25), the treatment group were given by microscopic spermatic vein ligation combined lower abdomen stasis soup, one dose a day, morning and evening for three months. In the control group, only microscopical spermatic vein ligation was performed. Results All the patients were successfully operated, the postoperative symptoms disappeared, the sperm concentration, semen volume and sperm activity were significantly increased, and the percentage of abnormal sperm was significantly decreased, the difference was statistically significant(P<0.05). The semen parameters of the patients in the treatment group with shaofu zhuyu decoction improved significantly after 3 months, there was significantly better than the control group. Conclusions Microscopical spermatic vein ligation combined with shaofu zhuyu decoction for the treatment of asthenospermia caused by varicocele has a satisfactory effect and the semen quality has been improved obviously. Key words: Varicocele; Asthenozoospermia; Ligation; CHINESE PATENT DRUGS

Folic Acid and Zinc Supplementation Still Does Nothing for Semen Quality

In the absence of data, folic acid and zinc supplementation continues to be promoted for improving semen quality in men who are part of infertile

Гистеросальпингосонография с применением раствора перекиси водорода в диагностике трубного, яичникового и маточного факторов женского бесплодия

КГБОУ ДПО «Институт повышения квалификации специалистов здравоохранения» министерства здравоохранения Хабаровского края проводит профессиональную переподготовку и повышение квалификации медицинских специалистов высшего и среднего звена, а также обучение в интернатуре, аспирантуре, ординатуре.

İnfertilite Tanısı Konmuş Kadınlarda Yaşam Kalitesi

İnfertilite Tanısı Konmuş Kadınlarda Yaşam Kalitesi

Polycystic ovarian syndrome in adolescents: From diagnostic criteria to therapeutic management.

Polycystic ovarian syndrome is a common endocrinologic condition diagnosed in women of childbearing age. It is primarily associated with androgen excess and ovarian dysfunction, which contribute to menstrual irregularity, oligo-anovulation, infertility, hirsutism and acne. It is associated with several systemic conditions, including type 2 diabetes mellitus, cardiovascular disease, obesity and neuropsychological disorders. The exact pathophysiology and clinical features are highly variable and, thus, there is still controversy in defining the diagnostic criteria. In this review, we outline the main diagnostic criteria, discuss the mechanisms involved in the complex pathogenesis, and present the associated clinical manifestations and therapeutic management of the syndrome in adolescents. (www.actabiomedica.it)

Application value of estradiol in seminal plasma in predicting semen parameters of male infertile patients

Objective To research the correlation between estradiol in seminal plasma and semen parameters of male infertile patients and to explore the value of seminal estradiol in predicting sperm quality. Methods A total of 86 infertility men who visited the reproductive center of our hospital from October to December 2018 were randomly selected and were measured semen parameters according to the WHO laboratory standard. We also tested seminal plasma estradiol by chemiluminescence. The patients were divided into four groups according to the seminal parameters: oligozoospermia (group 1, n=12), asthenospermia (group 2, n=24), oligoasthenozoospermia (group 3, n=24), normozoospermia (group 4, n=26). Results The level of estradiol in seminal plasma in group 1 to 4 were respectively (56.97±10.55) pg/ml, (52.30±8.64) pg/ml, (54.02±11.63) pg/ml, and (45.79±5.87) pg/ml, with statistically significant difference (P<0.01). The correlation analysis showed that the seminal plasma estradiol was negatively correlated with sperm concentration and sperm progressive motility, was not correlated with sperm normal morphology and sperm acrosin activity. The ROC curve of estradiol was drawn for the diagnosis of abnormal sperm. The cut off value of curve was 42.50 pg/ml, the sensitivity was 90.00%, the specificity 69.23%, the area under the curve was 0.737 (P<0.01), and the 95% confidence interval was (0.634, 0.840). Conclusion Seminal plasma E2 more than 42.50 pg/ml may be connected with abnormal sperm counts and vitality. Therefore, seminal plasma estradiol has certain forecastable value, which can be used as evaluation index of the diagnosis and treatment of male infertility patients. Key words: Estradiol; Sperm motility parameters; Sperm morphology; Acrosin

Мужское бесплодие в Российской Федерации: статистические данные за 2000-2018 годы

Мужское бесплодие в Российской Федерации: статистические данные за 2000-2018 годы

The level of matrix metalloproteinases and their tissue inhibitors in women with human papillomavirus infection and infertility

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Effect of ureaplasma urealyticum infection on sperm quality and sperm cytokine concentration

Objective To investigate the effects of ureaplasma urealyticum(Uu) infection on male sperm quality, nitric oxide(NO) concentration and cytokine interleukin (IL)-17, IL-18 and tumor necrosis factor alpha(TNF-α) concentrations, the mechanism of its action in male infertility was analyzed at the molecular level. Methods From September 2015 to December 2017, 53 male infertility patients who admitted in the outpatient clinic of the Second People's Hospital of Lianyungang were selected.According to whether the patients were infected Uu, they were divided into two groups: male infertility without Uu infection group (B group) and male infertility with Uu infection group (C group, Uu≥107CCU/L). The content of NO in seminal plasma was determined by nitrate reductase method.The contents of cytokines IL-17, IL-18 and TNF-α were detected by flow cytometry microsphere capture chip technique (CBA), and the spermate-related parameters were analyzed in conjunction with the computer-aided semen analysis system(CASA). Results The concentration of NO in the male infertility group with Uu infection group[(145.98±32.28)μmol/L] was significantly higher than that in the male infertility without Uu infection group [(60.93±16.62)μmol/L] and the control group [(35.92±1.73)μmol/L](F=200.987, P<0.01). The semen pH(6.09±0.14), sperm concentration [(26.64±8.34)×106/mL], and forward movement rate(a+ b) [(21.46±6.88)%], sperm survival rate [(28.92±9.17)%] and sperm morphology normal rate [(10.12±4.97)%] in the male infertility group with Uu infection were significantly lower than those in the male infertility without Uu infection group and the control group(all P<0.01). And the concentration of NO in the semen of males waspositively correlated with the concentrations of IL-17, IL-18 and TNF-α(R2=0.916 8, 0.863 0, 0.878 9, all P<0.01). The concentrations of IL-17 and IL-18 were positively correlated(R2=0.934 4, P<0.01). Conclusion Uu infection in infertility patients can cause high NO concentration.The levels of cytokines IL-17, IL-18 and TNF-α are positively correlated with the concentration of NO.The imbalance of various cytokines may be one of the causes of male infertility. Key words: Male infertility; Infection; Ureaplasma urealyticum; Interleukin-17; Interleukin-18; TNF-α; Cytokine; Nitric oxide